The American Heart Association has updated a guideline for the prevention of
CVD. Table below is a summary that presents goals and recommendations to achieve the
goals of reducing risks in children and adolescents identified as at high risk
for future CVD.

Risk Identification

Treatment Goals

Recommendations

Blood Cholesterol

>170 mg/dL
is borderline

>200 mg/dL
is elevated

LDL-C:

>110 mg/dL
is borderline

>130 mg/dL
is elevated.

Goals:

LDL-C

<160
mg/dL

(<130 mg/dL
is even better)

For patients
with diabetes,

LDL-C <100
mg/dL

If LDL-C is
above goals, initiate additional therapeutic lifestyle changes, including diet
(<7% of calories from saturated fat; <200 mg cholesterol per day), in
conjunction with a trained dietitian.

Consider
LDL-lowering dietary options (increase soluble fiber by using age [in years]
plus 5 to 10 g up to age 15, when the total remains at 25 g per day) in
conjunction with a trained dietitian.

Consider
pharmacologic therapy for individuals with LDL >190 mg/dL with no other risk
factors for CVD or >160 mg/dL with other risk factors present (blood pressure
elevation, diabetes, obesity, strong family history of premature CVD).

Pharmacologic
intervention for dyslipidemia should be accomplished in collaboration with a
physician experienced in treatment of disorders of cholesterol in pediatric
patients.

Other Lipids and Lipoprotein

Triglycerides:

>150 mg/dL
HDL-C <40 mg/dL

Goals:

Fasting
TG

<150
mg/dL

HDL-C >40
mg/dL

Elevated
fasting TG and reduced HDL-C are often seen in the context of overweight with
insulin resistance. Therapeutic lifestyle change should include weight
management with appropriate energy intake and expenditure. Decrease intake of
simple sugars.

If fasting
TGs are persistently elevated, evaluate for secondary causes such as diabetes,
thyroid disease, renal disease, and alcohol abuse.

No
pharmacologic interventions are recommended in children for isolated elevation
of fasting TG unless this is very marked (treatment may be initiated at TG
>400 mg/dL to protect against postprandial TG of 1000 mg/dL or greater, which
may be associated with an increased risk of pancreatitis).

Pharmacologic
management of hypertension should be accomplished in collaboration with a
physician experienced in pediatric hypertension.

Weight

BMI:

>85th
percentile is at risk of overweight

>90th
percentile is overweight

Goal:

>Achieve and
maintain BMI <95th percentile for age and sex

For children
who are at risk of overweight (>85th percentile) or obesity (>95th
percentile), a weight management program should be initiated with appropriate
energy balance achieved through changes in diet and physical activity.

For children
of normal height, a secondary cause of obesity is unlikely.

Weight
management should be directed at all family members who are overweight, using a
family-centered, behavioral management approach.

Weight
management should be done in collaboration with a trained dietitian.

Diabetes

Near-normal
fasting plasma glucose (<120 mg/dL)

Near-normal
HbA1c (<7%) (goals for fasting glucose and HbA1c should
take into consideration age and risk of hypoglycemia)

Management of
type 1 and type 2 diabetes in children and adolescents should be accomplished in
collaboration with a pediatric endocrinologist.

For type 2
diabetes, the first step is weight management with improved diet and
exercise.

Because of
risk for accelerated vascular disease, other risk factors (e.g., blood pressure,
lipid abnormalities) should be treated more aggressively in patients with
diabetes.

Cigarette Smoking

Complete cessation of smoking for children and parents who
smoke

Advise every tobacco user (parents and children) to quit and be
prepared to provide assistance with this (counseling/referral to develop a plan
for quitting using available community resources to help with smoking
cessation).